Left ventricular ejection fraction is determined by both global myocardial strain and wall thickness

• Published in: International journal of cardiology. Heart & vasculature 2015-06, Vol.7 (C), p.113-118
• Main Authors: MacIver, David H., Adeniran, Ismail, Zhang, Henggui
• Format: Article
• Language: English
• Subjects: Ejection fraction; Heart failure; Mathematical modelling; Pathophysiology
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2015.03.007

The purpose of this study was to determine the mathematical relationship between left ventricular ejection fraction and global myocardial strain. A reduction in myocardial strain would be expected to cause a fall in ejection fraction. However, there is abundant evidence that abnormalities of myocardial strain can occur with a normal ejection fraction. Explanations such as a compensatory increase in radial or circumferential strain are not supported by clinical studies. We set out to determine the biomechanical relationship between ejection fraction, wall thickness and global myocardial strain. The study used an established abstract model of left ventricular contraction to examine the effect of global myocardial strain and wall thickness on ejection fraction. Equations for the relationship between ejection fraction, wall thickness and myocardial strain were obtained using curve fitting methods. The mathematical relationship between ejection fraction, ventricular wall thickness and myocardial strain was derived as follows: φ=e(0.14Ln(ε)+0.06)ω+(0.9Ln(ε)+1.2), where φ is ejection fraction (%), ω is wall thickness (cm) and ε is myocardial strain (−%). The findings of this study explain the coexistence of reduced global myocardial strain and normal ejection fraction seen in clinical observational studies. Our understanding of the pathophysiological processes in heart failure and associated conditions is substantially enhanced. These results provide a much better insight into the biophysical inter-relationship between myocardial strain and ejection fraction. This improved understanding provides an essential foundation for the design and interpretation of future clinical mechanistic and prognostic studies. •Ejection fraction has a limited value in predicting mortality and functional capacity.•Myocardial mechanics including the relationship between myocardial strain and ejection fraction are currently poorly understood.•We showed that there is biophysical relationship between end-diastolic wall thickness, myocardial strain and ejection fraction.•Such a relationship explains the poor correlation of ejection fraction with prognosis and functional capacity.•The study provides the foundation for determining the relationship between ventricular hypertrophy, ejection fraction and prognosis.•words